AB0428 TREATMENT PATTERNS OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN TAIWAN – A POPULATION-BASED ANALYSIS
Authors: Y. S. Chang, W. N. Huang, C. H. Tang, K. Ng, P. Y. Chuang, W. Furnback, B. Wang, C. Y. Wei, B. Wang, T. Treuer
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease of an unknown etiology with a broad spectrum of organ manifestations, and patients with SLE have limited treatment options to NSAIDS, glucocorticoids, hydroxychloroquine and immunosuppressants. There is a lack of real-world evidence related to treatment patterns of SLE patients in Taiwan. Objectives To describe the real-world patient demographics, clinical characteristics, and treatment patterns of patients with SLE in Taiwan. Methods A retrospective observational study using Taiwan’s National Health Insurance Research Database (NHIRD) from 1/1/2014 to 12/31/2019 was undertaken. Patients holding catastrophic illness certificates for SLE in 2015-2017 were identified. Enrolled patients aged ≥ 18 years were then divided into three groups (mild, moderate, and severe) based on the highest severity patients experienced in the one year following the enrollment date using a published claims-based algorithm (Garris et al 2013) that incorporates the Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure, British Isles Lupus Assessment Group Index and expert clinical opinion, and indexed upon the first date of entering the severity group. Baseline patient characteristics and treatment patterns during the follow-up period were measured. The types of treatment considered were NSAIDs, glucocorticoids, hydroxychloroquine and immunosuppressants. Results A total of 20,181 patients with catastrophic illness certificates for SLE were included in this study. The mean age of all SLE patients was 46.5 years and patients were mostly female (89.1%). The mean Charlson Comorbidity Index (CCI) score of all SLE patients was 1.5 (SD 1.3). Of these patients, 29.3% (n=5,918) had mild SLE activity, 60.7% (n=12,253) moderate and 10.0% (n=2,010) severe. During the one-year follow-up period, moderate to severe patients had numerically higher utilization rate of all types of treatment compared with mild patients (Table 1). Of all oral glucocorticoid users,27.8% of severe patients used high-dose glucocorticoids (&gt; 15 mg/day) compared to &lt;0.1% for mild and 9.7% for moderate patients. More than 70.0% of moderate to severe patients were prescribed 2 or more types of treatment at the same point of time. Of these patients having concomitant treatment of glucocorticoids with immunosuppressants, glucocorticoid dosage increased with the number of immunosuppressant used, especially in severe patients. 80.4% of moderate to severe patients received glucocorticoid-based therapy as the first-line treatment and the median treatment duration was 3.1 months. The median treatment duration of each first-line immunosuppressant ranged from 0.9 to 4.8 months in moderate to severe patients. Table 1. SLE treatment utilization during the 1-year follow-up period Total (n=20,181 )` Mild (n=5,918 ) Moderate (n=12,253 ) Severe (n=2,010 ) n % n % n % n % NSAID 7,212 35.7 1,405 23.7 4,983 40.7 824 41.0 Glucocorticoid 14,019 69.5 2,015 34.1 10,297 84.0 1,707 84.9 Hydroxychloroquine 13,278 65.8 2,867 48.5 8,970 73.2 1,441 71.7 Immunosuppressant 7,630 37.8 0 0.0 6,319 51.6 1,311 65.2 Methotrexate 898 4.5 0 0.0 786 6.4 112 5.6 Azathioprine 5,642 28.0 0 0.0 4,843 39.5 799 39.8 Leflunomide 132 0.7 0 0.0 117 1.0 15 0.8 Cyclosporin 854 4.2 0 0.0 715 5.8 139 6.9 Mycophenolate 959 4.8 0 0.0 774 6.3 185 9.2 Cyclophosphamide 790 3.9 0 0.0 17 0.1 773 38.5 Conclusion The complexity and intensity of therapeutic approaches in SLE were associated with increased disease severity and patients were often resistant to treatment. These findings reflect the disease burden in SLE patients and suggest there is a substantial unmet need in the SLE treatment paradigm for moderate to severe SLE patients. References [1]Garris C, et al. J Med Econ. 2013;16:667–677. Disclosure of Interests Yu Sheng Chang: None declared, Wen-Nan Huang: None declared, Chao-Hsiun Tang: None declared, Khai Ng Shareholder of: I am a minor shareholder of Eli Lilly &amp; Company, Employee of: I am an employee of Eli Lilly &amp; Company, Po-Ya Chuang Consultant of: I am a paid consultant for Eli Lilly &amp;Company, Wesley Furnback Consultant of: I am a paid consultant for Eli Lilly &amp; Company, Bruce Wang Consultant of: I am a paid consultant for Eli Lilly &amp; Company, Ching-Yun Wei Shareholder of: I am a minor shareholder of Eli Lilly &amp; Company, Employee of: I am an employee of Eli Lilly &amp; Company, Bradley Wang Shareholder of: I am a minor shareholder of Eli Lilly &amp; Company, Employee of: I am an employee of Eli Lilly &amp; Company , Tamas Treuer Shareholder of: I am a minor shareholder of Eli Lilly &amp; Company, Employee of: I am an employee of Eli Lilly &amp; Company